Abstract
Objectives In many centers, training in cardiac surgery is considered to increase perioperative
risk. This study aims to test whether a resident working as the main operator is a
genuine risk factor.
Methods We analyzed patients who underwent elective isolated aortic valve replacement, elective
isolated coronary artery bypass grafting, or both, in our institution, from 2008 to
2016. Redo- and off-pump surgery, ejection fraction < 30%, and other concomitant procedures
were the exclusion criteria. After this selection, we included 3,077 patients in our
study. Within this group, 357 (11.6%) had been operated by residents and 2,720 (88.4%)
by senior surgeons. We performed propensity score matching using the nearest neighbor
method with a ratio of 1:2, considering the most important preoperative conditions.
In this way, the 357 patients operated by residents were matched with the 714 patients
who were operated by senior surgeons. The standardized mean differences were highly
reduced after matching, so both groups had similar risk profiles. We compared surgical
data, postoperative adverse events, and the 30-day mortality between the two groups.
Results The times of surgery, cardiopulmonary bypass, and cross-clamp were longer if residents
operated (p < 0.001). There were no differences regarding postoperative adverse events, time
of mechanical ventilation, and the intensive care unit length of stay. The 30-day
mortality rates of the two groups were very similar (p = 0.75, power = 0.8).
Conclusion Training in cardiac surgery is safe, and carefully selected patients can be operated
by residents without increased risk of perioperative mortality and complications.
Keywords
cardiac - heart valve surgery - coronary artery bypass grafting - CABG education,
all levels
